Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation.

Abstract

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n = 13) or a mean dosage of 0.07 mg/kg per day (n = 4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient, P < 0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in pre-adolescents receiving FK-506 but no prednisone (P < 0.02 and P < 0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.

• Authors: D Ellis, R Shapiro, M L Jordan, V P Scantlebury, N Gilboa, L Hopp, N Weichler, A G Tzakis, R L Simmons
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 8 Issue 2 Pg. 193-200 (Apr 1994) ISSN: 0931-041X [Print] Germany
• PMID: 7517171 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)

Chemical References

• Cyclosporine
• Tacrolimus

Topics

• Adolescent
• Child
• Child, Preschool
• Cyclosporine (administration & dosage, therapeutic use)
• Drug Evaluation
• Female
• Follow-Up Studies
• Graft Rejection (drug therapy)
• Graft Survival
• Growth (drug effects)
• Humans
• Hypertension (drug therapy)
• Infant
• Kidney (drug effects, physiology)
• Kidney Transplantation
• Male
• Tacrolimus (administration & dosage, therapeutic use)